Republican-led states, which have resisted Medicaid expansion for more than a decade, are showing new openness to the idea.
News promotion: More than a decade after the landmark Affordable Care Act was enacted, the 12 states with Republican-led legislatures are 138% below the poverty line (i.e., 10 per capita in 2022). We have not expanded Medicaid coverage to people living below about $19,000 a year.
- But there is evidence that the political winds are shifting in holdout states such as North Carolina, Georgia, Wyoming, Alabama, and Texas.
Important reasons: Expanding Medicaid, a key component of the Affordable Care Act, means increasing access to federal health insurance for low-income individuals in exchange for 10% of federal spending being shared by the state.
- Experts say this will increase access to health care, reduce uninsured rates and improve health for low-income people.
- More than 2 million Americans would benefit if 12 states expanded Medicaid, according to Kaiser Family Foundation estimates for 2021.
Big picture: Some Republican states are already expanding Medicaid through executive branch offices, or adopting citizen-led voting initiatives in states where it’s legal.
- Referendums on this issue were passed in Nebraska, Utah, and Idaho in 2018 and Missouri and Oklahoma in 2020.
- Medicaid expansion is on the ballot this November in Republican-controlled South Dakota. (June voters rejected a Republican proposal that would make it harder to pass.)
Be smart: Most of the remaining non-expanded states have neither voting initiative nor executive authority. The power to make decisions rests with Congress.
State of play: In Georgia, as first reported by Axios Atlanta, conversations are taking place behind the scenes with both parties about the way forward. It follows stunning support from North Carolina’s top Republicans for a sweeping expansion bill, first reported by Axios Raleigh this spring.
- Republican Senate Majority Leader Phil Berger reversed the stance at a news conference in May, saying, “If anyone speaks louder against Medicaid expansion than I do, I want to meet him.” . for us to do. ”
- Brian Robinson, former spokesman for the first Georgia governor who rejected Medicaid expansion, said in June it was time to make changes. , he told Axios Atlanta.
- Policy-wise, “this isn’t what we’re going to do,” Robinson said of Medicaid’s much-criticized structure. It will take home hundreds of millions of dollars from the programs we are already paying for. ”
What they say: “There is real momentum in expanding Medicaid in the conservative states that have held up so far,” says Melissa of Families USA, a health care advocacy group that works with partners in states that have not expanded to push policies forward. Burroughs said.
- Burroughs told Axios that there are Republicans in every non-expanded state who support or debate expansion, but often “political dynamics and leadership” get in the way.
Former Alabama Governor Robert Bentley, Having refused to expand Medicaid himself, he is now urging fellow Republicans to pass Medicaid for the benefit of the state’s rural communities.
- This year’s bipartisan legislative campaign on expansion has given hope to defenders of Wyoming.
- In Texas, the state with the highest percentage of uninsured people per capita, some Republicans co-support the Medicaid expansion bill. This shows that a “rift” is forming in the Republican opposition, said Luis Figueroa, Texan legislative and policy director at the progressive think tank Every He, Nicole Cobbler at Axios Austin. told Asher Price.
- The Republican lieutenant governor of Tennessee hinted at the possibility of opening up the policy last year, but there has been no meaningful legislative campaign.
detail: The wind is turning for a number of reasons, experts told Axios.
- money: The 2021 Federal Pandemic Relief Act sweetened deals in non-expanded states with provisions designed to fully offset state costs in the first two years. Republicans’ initial fears of withdrawing the matching fund have not materialized.
- COVID-19 (novel coronavirus infectious disease: Access to Medicaid was automatically extended under the federal government, which created a public health emergency. But these temporary allowances could be lifted next year, putting millions of people out of coverage and putting more pressure on leaders.
- Politics: Medicaid expansion continues to be widely supported, and the Republican campaign to “repeal and replace” the Affordable Care Act has failed in courts and Congress, crippling a once-important argument against expansion.
- Access to healthcare: As hospitals across the country close and rural health crises deepen, the benefits of receiving more reimbursement from additional Medicaid recipients are hard to ignore for local hospital revenues, but policy It is not a silver bullet to end the crisis.
conspiracy: Democrats in those states, including gubernatorial candidates like Stacey Abrams of Georgia and Beto O’Rourke of Texas, continue to campaign to push for Medicaid expansion.
- “I think a lot of Republicans want to extend Medicaid even more than they say,” said Texas Democrat Senator Nathan Johnson, who has pushed for expansion there, in Axios Austin’s Cobler and Price told to
- He said Republicans are “handcuffed by ideological and political constraints. They try to do something to help people, but they have to get over their reflexive opposition to the expansion of Medicaid.”
Yes, but: A proposal to expand Medicaid didn’t even get a board hearing in Texas in 2021.
Line spacing: Even in states that have not expanded, proposals for partial expansion have attracted attention.
- Nine out of 12 states are seeking or planning to extend postnatal Medicaid coverage for up to a year, according to Kaiser Health News.
- Some states, including South Carolina and Georgia, are pushing for partial expansion of Medicaid through labor requirement waivers that the Biden administration refused. Georgia has joined the ongoing nationwide legal battle over the constitutionality of labor requirements and has appealed its denial.
What we see: Even in a holdout state that is showing signs of momentum, the issue is still politically entangled.
- North Carolina’s most powerful politicians say this year’s state negotiations have been torpedoed by hospitals, but Democrats and Republicans alike are optimistic about the next session’s potential.
- In Georgia, while new talks are taking place, the exact legislative strategy is still unclear given the state’s November gubernatorial election is on the horizon.
- Figueroa said Texas remains a stumbling block because the governor and lieutenant governor are “reluctant to move.”
Nate Rau of Axios Nashville contributed to the report.
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